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        <div id="content">
            <div class="dropdown">
                <button style="width: 170px;" class="btn btn-default dropdown-toggle" type="button" id="dropdownMenu1" data-toggle="dropdown" aria-haspopup="true" aria-expanded="true">
                  <span id="btn-content">输血不良反应</span>
                  <span class="caret"></span>
                </button>
                <ul class="dropdown-menu" aria-labelledby="dropdownMenu1">
                  <li><a href="#">感染病例报告卡</a></li>
                  <li><a href="#">医疗医技异常事件</a></li>
                  <li><a href="#">护理异常事件</a></li>
                  <li><a href="#">输血不良反应</a></li>
                  <li><a href="#">医疗器械异常事件</a></li>
                  <li><a href="#">药物不良反应事件</a></li>
                  <li><a href="#">异常用药事件</a></li>
                  <li><a href="#">行政与后勤保障</a></li>
                  <li><a href="#">治安管理事件</a></li>
                </ul>
              </div>
              <div class="content-box1">
                <span>填表说明</span>
                <p>1.    暂存数据：保存填写的数据，下次可以进行补充修改，但是并没有提交</p>
            </div>
            <div class="content-box2">
                 <div class="content-box2-header">输入不良反应报告填写</div>
                 <div>
                    <div class="content-box2-top ">患者基本情况</div>
                    <div class="content-box2-form">
                        <form class="form-inline content-box2-form2">
                        <div class="form-group">
                          <label for="inputEmail3" class="col-sm-2 control-label">病历号：</label>
                          <div class="col-sm-10">
                            <input type="text" class="form-control" id="binli" placeholder="请输入准确的病历号后回车（门诊为就诊卡号）" style="width: 605px; margin-left: 20px;">
                          </div>
                        </div>
                        <div style="margin-top: 20px;">
                            <label for="inputEmail3">病人信息：</label>
                          <label for="exampleInputName2" style="margin-left: 86px;">姓名</label>
                          <input type="text" class="form-control" id="exampleInputName99" style="width: 154px;">
                          <label for="exampleInputName2" style="margin-left: 11px;">性别</label>
                                      <select style="width: 154px;" class="form-control">
                                        <option>男</option>
                                        <option>女</option>
                                      </select>
                          <label for="exampleInputName2" style="margin-left: 20px;">年龄</label>
                          <input type="text" class="form-control" id="exampleInputName2" style="width: 160px;">
                          </div>
                          <div style="margin-left: 60px; margin-top:20px">
                            <label for="exampleInputName2" style="margin-left: 100px;">民族</label>
                          <input type="text" class="form-control" id="exampleInputName2" style="width: 228px; margin-left: 30px;">
                          <label for="exampleInputName2" style="margin-left: 20px;">婚否</label>
                          <select style="width: 228px; margin-left: 30px;" class="form-control">
                            <option>---请选择---</option>
                            <option>保密</option>
                            <option>离异</option>
                            <option>未婚</option>
                            <option>已婚</option>
                          </select>
                          </div>
                          <div class="form-group" style="margin-top: 20px;">
                            <label for="inputEmail3">住院信息：</label>
                            <label for="exampleInputName2" style="margin-left: 86px;">科室</label>
                            <select style="width: 154px;" class="form-control">
                              <option>妇科</option>
                              <option>内分泌科</option>
                              <option>儿童心理科</option>
                              <option>儿科</option>
                              <option>产科</option>
                              <option>神经外科</option>
                              <option>眼科</option>
                            </select>
                          <label for="exampleInputName2" style="margin-left: 20px;">床号</label>
                          <input type="text" class="form-control" id="exampleInputName2" style="width: 154px;">
                          <label for="exampleInputName2" style="margin-left: 20px;">费用</label>
                          <input type="text" class="form-control" id="exampleInputName2" style="width: 154px;">
                          </div>
                          <div class="form-group" style="margin-top: 20px;">
                            <label for="inputEmail3">住院时间：</label>
                            <label for="exampleInputName2" style="margin-left: 86px;">入院</label>
                            <input type="date" class="form-control" id="exampleInputName2" style="width: 228px; margin-left: 30px;">
                            <label for="exampleInputName2" style="margin-left: 20px;">出院</label>
                            <input type="date" class="form-control" id="exampleInputName2" style="width: 228px; margin-left: 30px;">
                          </div>
                          <div class="form-group" style="margin-top: 20px;">
                            <label for="inputEmail3">住院天数：</label>
                            <input type="text" class="form-control" id="inputEmail3" style="width: 600px; margin-left: 91px;">
                          </div>
                        <div style="margin-top: 20px;">
                            <label for="inputEmail3">住院天数：</label>
                            <textarea class="form-control" rows="4" cols="80" style="margin-left: 88px;"></textarea>
                        </div>
                        <div style="margin-top: 20px;">
                            <label for="inputEmail3">预期治疗疾病或作用：</label>
                            <textarea class="form-control" rows="4" cols="80" style="margin-left: 17px;"></textarea>
                        </div>
                        <div class="form-group" style="margin-top: 20px;">
                            <label for="inputEmail3">血型：</label>
                            <label for="exampleInputName2" style="margin-left: 110px;">AOB血型</label>
                            <input type="text" class="form-control" id="AOBblood" style="width: 200px; margin-left: 30px;">
                            <label for="exampleInputName2" style="margin-left: 20px;">RDH血型</label>
                            <input type="text" class="form-control" id="RDHblood" style="width: 200px; margin-left: 30px;">
                          </div>
                    </form>
                    </div>
                    <div>
                        <div class="content-box2-top ">事件基本情况</div>
                        <div class="content-box2-form">
                            <form class="form-inline content-box2-form2">
                                <div class="form-group" style="margin-top: 20px;">
                                    <label for="inputEmail3">是否匿名上报：</label>
                                    <label class="radio-inline" style="margin-left: 63px;">
                                        <input type="radio" name="inlineRadioOptions" id="inlineRadio1" value="option1"> 否
                                      </label>
                                      <label class="radio-inline">
                                        <input type="radio" name="inlineRadioOptions" id="inlineRadio2" value="option2"> 是
                                      </label>
                                </div>
                            </form>
                            <form class="form-inline content-box2-form2">
                                <div style="margin-top: 20px;">
                                    <label for="inputEmail3">事件发生时期：</label>
                                    <input type="date" class="form-control" id="fashen" style="width: 600px; margin-left: 63px;">
                                </div>
                                <div class="form-group" style="margin-top: 20px;">
                                    <label for="inputEmail3">事件发生日期类型：</label>
                                      <select style="width: 600px; margin-left: 34px;" class="form-control">
                                        <option>---请选择---</option>
                                        <option>工作日</option>
                                        <option>法定节假日</option>
                                        <option>休息日</option>
                                      </select>
                                </div>
                                <div class="form-group" style="margin-top: 20px;">
                                    <label for="inputEmail3">事件发生的环境状态：</label>
                                    <select style="width: 600px; margin-left: 20px;" class="form-control">
                                        <option>---请选择---</option>
                                        <option>照明昏暗</option>
                                        <option>地面湿润</option>
                                        <option>走廊拥挤</option>
                                        <option>其他</option>
                                      </select>
                                </div>
                                <div style="margin-top: 20px;">
                                    <label for="inputEmail3">事件发生的场所：</label>
                                    <label class="radio-inline" style="margin-left: 46px;">
                                        <input type="radio" name="inlineRadioOptions" id="inlineRadio1" value="option1"> 门诊
                                      </label>
                                      <label class="radio-inline" style="margin-left: 37px;">
                                        <input type="radio" name="inlineRadioOptions" id="inlineRadio2" value="option2"> 急诊
                                      </label>
                                      <label class="radio-inline" style="margin-left: 37px;">
                                        <input type="radio" name="inlineRadioOptions" id="inlineRadio2" value="option2"> 住院
                                      </label>
                                </div>
                                <div style="margin-top: 3px;">
                                    <label class="radio-inline" style="margin-left: 162px;">
                                        <input type="radio" name="inlineRadioOptions" id="inlineRadio1" value="option1"> 手术麻醉
                                      </label>
                                      <label class="radio-inline">
                                        <input type="radio" name="inlineRadioOptions" id="inlineRadio2" value="option2"> 产房
                                      </label>
                                      <label class="radio-inline" style="margin-left: 37px;">
                                        <input type="radio" name="inlineRadioOptions" id="inlineRadio2" value="option2"> 医技科室
                                      </label>
                                </div>
                                <div style="margin-top: 3px;">
                                    <label class="radio-inline" style="margin-left: 162px;">
                                        <input type="radio" name="inlineRadioOptions" id="inlineRadio1" value="option1"> 共活动区
                                      </label>
                                      <label class="radio-inline">
                                        <input type="radio" name="inlineRadioOptions" id="inlineRadio2" value="option2"> 场所不明
                                      </label>
                                      <label class="radio-inline">
                                        <input type="radio" name="inlineRadioOptions" id="inlineRadio2" value="option2"> 其他场所
                                      </label>
                                </div>
                            </form>
                            <form class="form-inline content-box2-form2">
                                <div style="margin-top: 20px;">
                                    <label for="inputEmail3" style="width: 110px;">给患者造成损害的轻重程度：</label>
                                    <label style="margin-left: 45px;">Ⅰ级：发生错误，造成患者死亡</label>
                                </div>
                                <div style="margin-top: 3px;">
                                    <label class="radio-inline" style="margin-left: 162px;">
                                        <input type="radio" name="inlineRadioOptions" id="inlineRadio1" value="option1"> I级：导致患者死亡
                                    </label>
                                </div>
                                <div style="margin-top: 20px;">
                                    <label style="margin-left: 158px;">Ⅱ级：发生错误，且造成患者伤害</label>
                                </div>
                                <div style="margin-top: 3px;">
                                    <label class="radio-inline" style="margin-left: 162px;">
                                        <input type="radio" name="inlineRadioOptions" id="inlineRadio1" value="option1"> E级：造成患者暂时性伤害，并需要进行治疗或干预
                                    </label>
                                </div>
                                <div style="margin-top: 3px;">
                                    <label class="radio-inline" style="margin-left: 162px;">
                                        <input type="radio" name="inlineRadioOptions" id="inlineRadio1" value="option1"> F级：造成患者暂时性伤害，并需要住院或延长住院时间
                                    </label>
                                </div>
                                <div style="margin-top: 3px;">
                                    <label class="radio-inline" style="margin-left: 162px;">
                                        <input type="radio" name="inlineRadioOptions" id="inlineRadio1" value="option1"> G级：造成患者永久性伤害
                                    </label>
                                </div>
                                <div style="margin-top: 3px;">
                                    <label class="radio-inline" style="margin-left: 162px;">
                                        <input type="radio" name="inlineRadioOptions" id="inlineRadio1" value="option1"> H级：导致患者需要治疗挽救生命
                                    </label>
                                </div>
                                <div style="margin-top: 20px;">
                                    <label style="margin-left: 158px;">Ⅲ级：发生错误，但未造成患者伤害</label>
                                </div>
                                <div style="margin-top: 3px;">
                                    <label class="radio-inline" style="margin-left: 162px;">
                                        <input type="radio" name="inlineRadioOptions" id="inlineRadio1" value="option1"> B级：发生但未累及患者
                                    </label>
                                </div>
                                <div style="margin-top: 3px;">
                                    <label class="radio-inline" style="margin-left: 162px;">
                                        <input type="radio" name="inlineRadioOptions" id="inlineRadio1" value="option1"> C级：累及到患者，但没有造成伤害
                                    </label>
                                </div>
                                <div style="margin-top: 3px;">
                                    <label class="radio-inline" style="margin-left: 162px;">
                                        <input type="radio" name="inlineRadioOptions" id="inlineRadio1" value="option1"> D级：累及到患者，需要进行监测以确保患者不被伤害，或需通过干预阻止伤害发生
                                    </label>
                                </div>
                                <div style="margin-top: 20px;">
                                    <label style="margin-left: 158px;">Ⅳ级：错误未发生（错误隐患</label>
                                </div>
                                <div style="margin-top: 3px;">
                                    <label class="radio-inline" style="margin-left: 162px;">
                                        <input type="radio" name="inlineRadioOptions" id="inlineRadio1" value="option1"> A级：客观环境或条件可能引发不良事件（隐患）
                                    </label>
                                </div>
                                <div style="margin-top: 20px;">
                                    <label for="inputEmail3" style="width: 110px;">事件分类：*</label>
                                    <label style="margin-left: 45px;">警讯事件：</label>
                                    <label style="color: rgb(105, 102, 102);">
                                        涉及死亡或严重身体伤害或心理伤害的意外事件。严重身体伤害具体包括丧失四肢或功能。
                                    </label>
                                </div>
                                <div style="margin-top: 3px;">
                                    <label style="margin-left: 158px;">不良后果事件：</label>
                                    <label style="color: rgb(105, 102, 102);">
                                        造成机体或功能的损害的事件。
                                    </label>
                                </div>
                                <div style="margin-top: 3px;">
                                    <label style="margin-left: 158px;">未造成后果事件：</label>
                                    <label style="color: rgb(105, 102, 102);">
                                        虽然发生了错误事实，但未造成不良后果。
                                    </label>
                                </div>
                                <div style="margin-top: 3px;">
                                    <label style="margin-left: 158px;">临界差错事件：</label>
                                    <label style="color: rgb(105, 102, 102);">
                                        任何发现的缺陷或错误，未形成事实，未造成危害，但其再发生很有可能带来严重后果。
                                    </label>
                                </div>
                                <div style="margin-top: 20px;">
                                    <label for="inputEmail3">事件陈述：</label>
                                    <textarea class="form-control" rows="4" cols="80" style="margin-left: 85px;"></textarea>
                                </div>
                            </form>
                        </div>
                        <div>
                            <div class="content-box2-top ">输血基本情况</div>
                            <div class="content-box2-form">
                            <form class="form-inline content-box2-form2">
                                <div class="form-group" style="margin-top: 20px;">
                                    <label for="inputEmail3">不规则抗体：</label>
                                    <input type="text" class="form-control" id="inputEmail3" style="width: 600px; margin-left: 73px;">
                                </div>
                                <div style="margin-top: 20px;">
                                    <label for="inputEmail3">既往输血史：</label>
                                    <textarea class="form-control" rows="4" cols="80" style="margin-left: 73px;"></textarea>
                                </div>
                                <div class="form-group" style="margin-top: 20px;">
                                    <label for="inputEmail3">输血次数： *</label>
                                    <input type="text" class="form-control" id="inputEmail3" style="width: 600px; margin-left: 78px;">
                                </div>
                                <div style="margin-top: 20px;">
                                    <label for="inputEmail3">输血时间： *</label>
                                    <label for="exampleInputName2" style="margin-left: 78px;">起始时间</label>
                                    <input type="date" class="form-control" id="begin" style="width: 217px; margin-left: 10px;">
                                    <label for="exampleInputName2" style="margin-left: 20px;">截止时间</label>
                                    <input type="date" class="form-control" id="exampleInputName2" style="width: 217px; margin-left: 10px;">
                                </div>
                                <div style="margin-top: 20px;">
                                    <label for="inputEmail3">血液制剂名称： *</label>
                                    <label for="exampleInputName2" style="margin-left: 50px;">制剂名称</label>
                                    <input type="text" class="form-control" id="exampleInputName2" style="width: 211px; margin-left: 30px;">
                                    <label for="exampleInputName2" style="margin-left: 20px;">血型</label>
                                    <input type="text" class="form-control" id="exampleInputName2" style="width: 211px; margin-left: 30px;">
                                </div>
                                <div class="form-group" style="margin-top: 20px;">
                                    <label for="exampleInputName2" style="margin-left: 162px;">血袋编码</label>
                                    <input type="text" class="form-control" id="exampleInputName2" style="width: 211px; margin-left: 30px;">
                                    <label for="exampleInputName2" style="margin-left: 20px;">输血量</label>
                                    <input type="text" class="form-control" id="exampleInputName2" style="width: 211px; margin-left: 15px;">
                                </div>
                                <div style="margin-top: 20px;">
                                    <label for="inputEmail3">本次输血反应： *</label>
                                    <label class="radio-inline" style="margin-left: 46px;">
                                        <input type="radio" name="inlineRadioOptions" id="inlineRadio1" value="option1"> 发热
                                      </label>
                                      <label class="radio-inline" style="margin-left: 38px;">
                                        <input type="radio" name="inlineRadioOptions" id="inlineRadio2" value="option2"> 过敏
                                      </label>
                                      <label class="radio-inline" style="margin-left: 38px;">
                                        <input type="radio" name="inlineRadioOptions" id="inlineRadio2" value="option2"> 溶血
                                      </label>
                                </div>
                                <div style="margin-top: 3px;">
                                    <label class="radio-inline" style="margin-left: 157px;">
                                        <input type="radio" name="inlineRadioOptions" id="inlineRadio1" value="option1"> 细菌污染
                                      </label>
                                      <label class="radio-inline">
                                        <input type="radio" name="inlineRadioOptions" id="inlineRadio2" value="option2"> 血红蛋白
                                      </label>
                                      <label class="radio-inline" >
                                        <input type="radio" name="inlineRadioOptions" id="inlineRadio2" value="option2"> 其他
                                      </label>
                                </div>
                                <div style="margin-top: 20px;">
                                    <label for="inputEmail3">反应出现时间： *</label>
                                    <input type="date" class="form-control" id="exampleInputName2" style="width: 600px; margin-left: 45px;">
                                </div>
                                <div style="margin-top: 20px;">
                                    <label for="inputEmail3">反应症状： *</label>
                                    <textarea class="form-control" rows="4" cols="80" style="margin-left: 73px;"></textarea>
                                </div>
                                <div style="margin-top: 20px;">
                                    <label for="inputEmail3">反应治疗措施： *</label>
                                    <textarea class="form-control" rows="4" cols="80" style="margin-left: 45px;"></textarea>
                                </div>
                                <div class="form-group" style="margin-top: 20px;">
                                    <label for="inputEmail3">输血前后体温变化： *</label>
                                    <label for="exampleInputName2" style="margin-left: 17px;">输血前</label>
                                    <input type="text" class="form-control" id="exampleInputName2" style="width: 214px; margin-left: 30px;">
                                    <label for="exampleInputName2" style="margin-left: 20px;">输血后</label>
                                    <input type="text" class="form-control" id="exampleInputName2" style="width: 213px; margin-left: 30px;">
                                </div>
                                <div style="margin-top: 20px;">
                                    <label for="inputEmail3">备注：</label>
                                    <textarea class="form-control" rows="4" cols="80" style="margin-left: 110px;"></textarea>
                                </div>
                            </form>
                        </div>
                        </div>
                        <div>
                            <div class="content-box2-top ">报告者基本情况</div>
                            <div class="content-box2-form">
                                <form class="form-inline content-box2-form2">
                                    <div class="form-group" style="margin-top: 20px;">
                                        <label for="inputEmail3">报告人信息：</label>
                                      <label for="exampleInputName2" style="margin-left: 65px;">姓名*</label>
                                      <input type="text" class="form-control" id="exampleInputName2" style="width: 154px;">
                                      <label for="exampleInputName2" style="margin-left: 11px;">科室*</label>
                                      <select style="width: 154px;" class="form-control" id="keshi">
                                        <option>血液科</option>
                                        <option>新生儿小婴儿科</option>
                                        <option>康复科</option>
                                        <option>肾脏免疫科</option>
                                      </select>
                                      <label for="exampleInputName2" style="margin-left: 11px;">职称*</label>
                                      <select style="width: 154px;" class="form-control">
                                        <option>---请选择---</option>
                                        <option>初级</option>
                                        <option>中级</option>
                                        <option>副高</option>
                                        <option>高级</option>
                                        <option>无</option>
                                      </select>
                                    </div>
                                    <div style="margin-top: 20px;">
                                        <label for="exampleInputName2" style="margin-left: 153px;">民族*</label>
                                        <input type="text" class="form-control" id="exampleInputName2" style="width: 214px; margin-left: 30px;">
                                        <label for="exampleInputName2" style="margin-left: 20px;">职业*</label>
                                        <label class="radio-inline" style="margin-left: 30px;">
                                            <input type="radio" name="inlineRadioOptions" id="inlineRadio1" value="option1"> 医师
                                          </label>
                                          <label class="radio-inline" style="margin-left: 10px;">
                                            <input type="radio" name="inlineRadioOptions" id="inlineRadio2" value="option2"> 药师
                                          </label>
                                          <label class="radio-inline" tyle="margin-left: 10px;">
                                            <input type="radio" name="inlineRadioOptions" id="inlineRadio3" value="option3"> 护士
                                          </label>
                                          <label class="radio-inline" tyle="margin-left: 10px;">
                                            <input type="radio" name="inlineRadioOptions" id="inlineRadio3" value="option3"> 其他
                                          </label>
                                    </div>
                                    <div class="form-group" style="margin-top: 20px;">
                                        <label for="inputEmail3">联系信息：</label>
                                        <label for="exampleInputName2" style="margin-left: 80px;">电子邮箱*</label>
                                        <input type="text" class="form-control" id="exampleInputName2" style="width: 214px;">
                                        <label for="exampleInputName2" style="margin-left: 20px;">签名*</label>
                                        <input type="text" class="form-control" id="exampleInputName2" style="width: 235px; margin-left: 30px;">
                                    </div>
                                    <div  style="margin-top: 20px;">
                                        <label for="inputEmail3">单位信息：</label>
                                        <label for="exampleInputName2" style="margin-left: 80px;">单位名称</label>
                                        <input type="text" class="form-control" id="exampleInputName2" style="width: 214px; margin-left: 5px;">
                                        <label for="exampleInputName2" style="margin-left: 20px;">联系人</label>
                                        <input type="text" class="form-control" id="exampleInputName2" style="width: 235px; margin-left: 22px;">
                                    </div>
                                    <div  style="margin-top: 20px;">
                                        <label for="exampleInputName2" style="margin-left: 154px;">电话</label>
                                        <input type="text" class="form-control" id="exampleInputName98" style="width: 214px; margin-left: 33px;">
                                        <label for="exampleInputName2" style="margin-left: 20px;">报告日期</label>
                                        <input type="text" class="form-control" id="exampleInputName2" style="width: 235px; margin-left: 8px;">
                                    </div>
                                    <div  style="margin-top: 20px;">
                                        <button type="button" class="btn btn-warning" style="width: 200px; height: 40px; margin-left: 335px;" id="sub">确认提交</button>
                                        <button type="button" class="btn btn-default" style="width: 200px; height: 40px; margin-left: 20px;">暂存数据</button>
                                    </div>
                                </form>
                            </div>
                        </div>
                    </div>
                 </div>
            </div>
        </div>
        <script src="../js/Poor blood.js"></script>
</body>
</html>